Non-communicable diseases (NCDs) have become a major public health problem accounting for a considerable share of the national health burden in Sri Lanka. The rapidly increasing magnitude of these diseases is contributing to widening health disparities between and within countries and increasing healthcare budget.
To reduce vulnerability to NCDs where Diabetes is one of the leading risk factors, the Sri Lanka Medical Association has introduced a novel concept : aerobics, with medics setting the pace as role models for the community at large.
Asked why doctors were selected to be the role models, President, SLMA Professor Chandrika Wijeyaratne , told the Sunday Observer, “ As most of the doctors who work hard tend to spend a sedentary lifestyle and have got used to unhealthy habits, they have become a more vulnerable group for NCDs and its complications.
As the most responsible and trusted healthcare professionals in the country, doctors are ethically bound to practise what they preach to their clients and be role models to society.
We are happy to inform you that about 50 doctors and staff participated in the Healthy Medics program which consisted of Zumba and social dance sessions over the period of the month of November 2017.
“We are hoping to continue the program starting March 2018 onwards”.
The Sunday Observer Health also spoke to General Physician, Ministry of Health, Dr Ramya L. Premaratne who gave us an on site view of the Nirogi Project funded by the World Diabetes Foundation. She discussed how it has impacted on relatively neglected, but important risk factors relating to primary prevention of NCDs in highly vulnerable populations, especially, those at risk of diabetes which is widespread among young and old, and offered useful advice on losing weight with healthy diets for those who are obese.
Following are excerpts ...
Q. What is the background of Nirogi Lanka program?
A. The NIROGI Lanka project of Sri Lanka Medical Association, funded by the World Diabetes Foundation since, has shown excellent results in providing a nationally relevant model for tackling the Non Communicable Disease burden in the country. In collaboration with the Ministry of Health and partnerships with all stakeholders, the Project has ably impacted on relatively neglected, but important risk factors in relation to primary prevention of NCDs in highly vulnerable populations..
The Ministry of Health has identified that local evidence of ‘best buys’ should be combined and incorporated into the existing PHC system. This would entail scaling up the delivery of prevention and control measures through the empowerment of vulnerable populations towards healthy lifestyles.
The project will be expanded for the next two years with financial contribution of the World Bank through the Second Health Sector Development Project (SHSDP) of the Ministry of Health, Sri Lanka.
Q. What is the goal for promoting an Aerobic program in Sri Lanka?
A. To prevent diabetes mellitus and cardiac diseases through community based interventions in vulnerable populations, based on the lessons learnt in the inaugural NIROGI Lanka project component .
Q. What are the objectives?
A. Each year, 15 million people die prematurely from largely avoidable risks – tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity. They are ‘avoidable’ because action can be taken by governments, the private sector and others to reduce the global burden of non communicable diseases. The needless deaths of so many millions of people, mostly from low- and middle-income countries, is one of the 21st century’s major health and socioeconomic crises. Therefore this program will help countries meet global targets to reduce deaths from NCDs by 25% by 2025.
Q. Who are the target group?
A. Communities living in the urban, suburban and rural sectors in the district of Colombo. Work places with more than 1,000 workers in Colombo, National, Non-national and International Schools in the district of Colombo
Q. Describe some of the Project activities and how they are evaluated.
A. Process used and the medium/long term outcomes of the model will be evaluated through an independent review process using the behavioural indicators developed by the Ministry of Health. These indicators are related to diet, physical activities, tobacco, alcohol and mental stress, and will be further modified following in-depth interviews and focus group discussions with relevant stakeholders.
An advocacy package that focuses on addressing the underlying behavioural risk factors of diabetes and cardio vascular diseases ( CVD) at area level and the support expected from them will be developed. Policy makers will be encouraged to provide a supportive physical environment for people to have healthy behaviour.
Periodic reviews of the established settings will be carried out with the participation of relevant stakeholders to solicit the support of other sectors. Home gardening, foot paths for walking, no-tobacco boutiques/shops, healthy food outlets, community exercise programs, etc will be established through social mobilization and inter-sectorial collaboration.
Based on the lessons learnt, to establish the NIROGI Lanka health promotion model in different settings among the most vulnerable groups of people through capacity building of the vulnerable groups as Health Promotion Facilitators (HPF), providing a supportive environment to change, and monitoring and evaluation of their progress.
Q. What are the important findings unveiled by your recent research on these diseases, especially, the spread of diabetes ?
A. Research evidence suggests that urbanization and its ensuing sedentary lifestyle play a key role in the accumulation of risk factors of diabetes. In view of this, schoolchildren, adolescents and working population of middle and upper income class living/working in areas of Colombo representing the most urbanized areas of Sri Lanka are identified as the target groups for health promotion as they are the most prone to unhealthy food habits related to fibre and transfats, less physical activities related to occupation/school, transport and recreation, stressful work/school environment and substance use.
Q. What are the settings and target groups for this program?
A. Three settings and target groups are identified for health promotion:
1. To initiate ‘healthy worker settings’ using productivity enhancement approach. To this end, five work settings in Colombo with more than 1,000 workers per setting will be selected. Employees of different strata, including executive and managerial levels will be targeted in this activity. Initially, 20 employees from each setting will undergo capacity building in health promotion as Health Promotion Facilitators (HPF) and another 30 at later stages. Identification and motivation of these HPF in health promotional work will be done via already existing systems in institutions such as, productivity enhancement workshops that target employees.
Health promotional activities too will be introduced through the same productivity enhancement approach. Advocacy programs at managerial level will address issues related to supportive environments within work settings.
Q. How many workers are expected to be trained under the Project?
A. The Project envisages to train 250 employees as HPF (primary target group) and thereby about 5,000 employees in HP (secondary target group).
2. To initiate a cohort of schoolchildren as ‘health messengers’ for school and family based health promotion in collaboration with the Ministry of Education.
Five secondary schools with more than 1,000 students each will be selected from Government (2 schools), Private (2 schools) and International (1 school) schools in the Colombo Municipal Council areas. This project intends to train schoolchildren as ‘health messengers’ and incorporate the life-cycle approach of NCD into the school curriculum and assessments in collaboration with the Ministry of Education. This project envisages to train initially about 125 schoolchildren from the five schools and later up to 2,000 schoolchildren as ‘health messengers’ (primary target group) and 10,000 family members of students (secondary target group).
3. To initiate new settings in a relatively rural community
Through further capacity building of participants of the project as HPF, 10 new settings will be established in a relatively rural community. This project envisages training initially 10 community participants as HPF and later up to 200 HPF (primary target group) and thereby about 1,000 family members (secondary target group).
4. To maintain the health data / information management system from family to Division
- A cohort of families in public health midwife areas consisting of about 3,000 population in each
- A cohort of high risk population (1,000 adults employed in sedentary settings)
Q. What about women who develop gestational diabetes after delivery?
A. The Ministry will establish a cohort of 300 post-partum women with gestational diabetes to evaluate the change in behaviour and outcomes in integration with the NIROGI Maatha
Participants of the above settings will be followed up, to monitor and update the risk factors of diabetes and CVD for long term management via the already established Health Information System (HIS) of the NIROGI Lanka project. In all three databases, fasting plasma glucose and behaviour-related risk factors will be assessed at baseline and thereafter periodically.
Q. A lot of publicity has been given lately to healthy eating. Give us more details on this.
A. We offer 12 Tips to lose weight on the 12-week plan
1. Don’t skip breakfast
Skipping breakfast won’t help you lose weight. You could miss out on essential nutrients and may end up snacking more throughout the day because you feel hungry. Check out five healthy breakfasts.
2. Eat regular meals
Eating at regular times during the day helps burn calories at a faster rate. It also reduces the temptation to snack on foods high in fat and sugar. Find out more about eating healthily.
3. Eat plenty of fruit and vegetables
Fruit and veggies are low in calories and fat, and high in fibre – three essential ingredients for successful weight loss. They also contain plenty of vitamins and minerals.
4. Get more active
Being active is key to losing weight and keeping it off. As well as providing numerous health benefits, exercise can help burn off the excess calories you can’t cut through diet alone. Find an activity you enjoy and are able to fit into your routine.
5. Drink plenty of water
People sometimes confuse thirst with hunger. You can end up consuming extra calories when a glass of water is really what you need.
6. Eat high-fibre foods
Foods containing lots of fibre can help keep you to feel full, which is perfect for losing weight. Fibre is only found in food from plants, such as fruit and vegetable, oats, wholegrain bread, brown rice and pasta, and beans, peas and lentils.
7. Read food labels
Knowing how to read food labels can help you choose healthier options. Use the calorie information to work out how a particular food fits into your daily calorie allowance on the weight loss plan. Find out more by reading food labels.
8. Use a smaller plate
Using smaller plates can help you eat smaller portions. By using smaller plates and bowls, you may be able to gradually get used to eating smaller portions without going hungry. It takes about 20 minutes for the stomach to tell the brain it’s full, so eat slowly and stop eating before you feel full.
9. Don’t ban foods
Don’t ban any foods from your weight loss plan, especially, the ones you like. Banning foods will only make you crave them more. There’s no reason you can’t enjoy the occasional treat as long as you stay within your daily calorie allowance.
10. Don’t stock junk food
To avoid temptation, try to not stock junk food – such as chocolate, biscuits, crisps and sweet fizzy drinks – at home. Instead, opt for healthy snacks, such as fruit, unsalted rice cakes, oat cakes, unsalted or unsweetened popcorn, and fruit juice.
11. Cut down on alcohol
A standard glass of wine can contain as many calories as a piece of chocolate. Over time, drinking too much can easily contribute to weight gain. Find out more about the calories in alcohol.
12. Plan your meals
Try to plan your breakfast, lunch, dinner and snacks for the week, making sure you stick to your calorie allowance. You may find it helpful to make a weekly shopping list.
Q. Finally,who are the responsible officials in this program?
A. The District Health Promoting Officer (HPO) is assigned to a District for whom he/she is responsible. The HPO is expected to live in that area.
The HPO is expected to be a role model unless it would be difficult to change the mind-set of the community.
During the time of internal inspection (Once in three months), the work of the HPO will assess that the focus of health promotion is on prevention. It involves working with a population group and designing programs that assist the health of that group.
Health Promotion Officer helps people to improve their health and increase their control over it.
The role of HPO may vary from giving face-to-face advice to individuals to producing strategic policies for health promotion. They may set up schemes promoting a healthy lifestyle, run campaigns and implement government initiatives relating to public health.
Q. What are the Responsibilities?
A.
- Developing health policies and strategies for promoting health at local level which supports the regional and national level policy changes;
- Planning, developing, implementing, monitoring and evaluating project activities to promote health improvement;
- Facilitating and supporting a wide range of statutory, voluntary, charitable, government, non-government and commercial organizations in their delivery of health promotion activities;
- Developing the health awareness of individuals, groups and organizations and empowering them to make healthy choices; leading, supporting, or cooperating in multi-agency projects to promote a healthy context or social environment;
- Running training courses and workshops in areas such as, mental health, accident prevention, cancers and heart disease; developing and supporting local partnerships to broaden the local response to health inequalities;
- Identifying training needs arising from strategic and local agendas and developing and delivering appropriate training for people such as health promotion activists and volunteers;
- providing specialist advice and resources to other agencies, such as schools, local communities, workplaces and community based organizations; ensuring that work is underpinned by sound, up-to-date knowledge of health promotion theory and making sure that projects are based on evidence of effectiveness;
- lobbying for increased recognition of preventative and promotional measures that can take place at a population level and which have a positive impact on the health of a community;
- writing and producing leaflets, posters, videos and brochures to aid health promotion in different environments..
Q. What does the working day involve?
A. n HPO’s typical working day means that he/she spends his/ her entire working hours with the people. “have meetings with representatives of different cultural groups and lots of on-site visits. He/she might visit schools to assess their healthcare needs, run a presentation about promoting health to a government ministers or meet with groups in community health centers. Also he/she needs to present at the relevant meetings which are held in RDHS/PDHS or MOHs as required.
- HPO works around 45 hours a week. “A lot of commitments, like meetings with community groups, are held outside normal hours. There may be weekend work too as per community requirements.
- HPOs should provide weekly and monthly reports as per the requirement and the specifications given by the project office.
Q. What is the nature of the setting to provide the service?
A. Health Promotion Officers work in a wide range of settings, including:
- Hospitals (including primary health care units like HLCs and MOHs);
- schools;
- prisons / Rehabilitation centers;
- workplaces (Government or non-government);
- neighbourhoods;
- communities;
- Community Based Organizations (CBOs like Maranadhara sammithi, Women’s clubs etc.)
Q. What are the other issues considered in this program?
A. They educate on a number of different health-related issues, such as:
- Drug use;
- The dangers of smoking;
- Excessive alcohol consumption;
- Lack of Physical activities
- Healthy eating;
- Sexual health;
- Mental health;
Their work may be focused on a specific section of the community, such as, elderly or disabled people or an ethnic minority groups.